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org

Pregnancy outcomes in women with polycystic

ovary syndrome: a metaanalysis
Lucinda E. Kjerulff, MD; Luis Sanchez-Ramos, MD; Daniel Duffy, MD

OBJECTIVE: The purpose of this study was to examine which maternal tension, preeclampsia, preterm delivery, cesarean delivery, operative
and neonatal complications are associated with polycystic ovary syn- vaginal delivery, SGA, and large-for-gestational age. Only gestational
drome (PCOS) in pregnant women. diabetes mellitus, pregnancy-induced hypertension, preeclampsia,
STUDY DESIGN: The studies that were included compared pregnancy preterm delivery, and SGA infants were found to be statistically
outcomes between women with PCOS and those without diagnosed significant.
PCOS. Our primary outcomes included gestational diabetes mellitus, CONCLUSION: This metaanalysis confirms the higher association of
pregnancy-induced hypertension, and preeclampsia. Secondary out- pregnancy complications and PCOS compared with patients who do not
comes included cesarean delivery rates, operative vaginal delivery have PCOS. Additionally, there may be a stronger association between
rates, preterm delivery, small-for-gestational-age (SGA) infants and PCOS and hypertensive disorders than has been shown previously.
large-for-gestational-age infants.
RESULTS: We found that PCOS in pregnancy was associated with Key words: complication, gestational diabetes mellitus, polycystic
higher rates of gestational diabetes mellitus, pregnancy-induced hyper- ovary syndrome

Cite this article as: Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis. Am J Obstet Gynecol
2011;204:558.e1-6.

P olycystic ovary syndrome (PCOS) is

estimated to affect at least 5–15% of
reproductive-aged women and is there-
with menstrual irregularities, decreased
fertility, insulin resistance, diabetes mel-
litus, and hyperandrogenism.2 For this
lated to multiple births.9 Since that
report, 8 relevant studies have been pub-
lished, which includes one that has dis-
fore one of the most common endocrine population to become pregnant, many puted the increased risk of preeclampsia,
abnormalities worldwide.1 Despite its women require assisted reproductive preterm delivery, polyhydramnios, oli-
prevalence, PCOS is a disease with an techniques in addition to the medical gohydramnios, macrosomia, and ad-
unclear cause, varying diagnostic crite- treatment of insulin insensitivity.3-5 verse infant outcomes.10 In view of these
ria, expansive clinical effects, and de- Once this previously subfertile popula- new reports, we conducted an updated
batable management. In nonpregnant tion becomes pregnant, the effect of metaanalysis to reevaluate the risks of
women, PCOS is known to be associated maternal insulin insensitivity and hy- gestational diabetes mellitus, pregnancy-
perandrogenism on the fetus must be induced hypertension, preeclampsia, ce-
considered. sarean delivery, preterm delivery, and
From the Department of Obstetrics and
Pregnant women without PCOS have operative vaginal delivery.
Gynecology, University of Florida College of
a natural state of insulin resistance.6,7
Medicine–Jacksonville, Jacksonville, FL.
With the additive effect of PCOS, this M ATERIALS AND M ETHODS
Presented at the 73rd Annual Meeting of the
South Atlantic Association of Obstetricians and baseline insulin resistance may worsen We reviewed computerized databases,
Gynecologists, Hot Springs, VA, Jan. 30-Feb. and lead to gestational diabetes mel- references of published articles, and text-
2, 2011. litus and its consequences. Additionally, book chapters to find articles that would
Received Oct. 4, 2010; revised Feb. 17, 2011; women with PCOS have been shown to meet the inclusion criteria. Comput-
accepted March 9, 2011. have a low amount of insulin-like growth erized databases included MEDLINE
Reprints: Lucinda Esenam Kjerulff, MD, factor binding globulin-1 that may con- (Pubmed, NLM Gateway) and Cochrane
Resident Physician (PGY3), 653-1 West 8th tribute to preeclampsia and growth ab-
St., Department of Obstetrics and Gynecology, Library.
University of Florida College of
normalities.8 An earlier metaanalysis in
Medicine–Jacksonville, Jacksonville, FL 2006 found that women with PCOS had Study selection
32246. [email protected]. a significantly higher risk of experiencing To examine the association between
Authorship and contribution to the article is gestational diabetes mellitus, pregnancy- PCOS and pregnancy complications, we
limited to the 3 authors indicated. There was induced hypertension, preeclampsia, searched for studies from 1966 to April
no outside funding or technical assistance with and preterm birth. Additionally, infants 2010 in which outcomes were compared
the production of this article.
of women with PCOS also had a signifi- between women with PCOS and women
0002-9378/$36.00
cantly higher risk of admission to a neo- without diagnosed PCOS. Because most
© 2011 Published by Mosby, Inc.
doi: 10.1016/j.ajog.2011.03.021 natal intensive care unit and a higher of the studies were performed before the
perinatal mortality rate that was unre- revised 2006 Androgen Excess and Poly-

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cluded cesarean delivery rates, op- abstract. Of the remaining, 37 articles, 14

FIGURE
erative vaginal delivery rates, preterm articles were excluded because 4 lacked a
Flowchart of study selection
delivery, small-for-gestational age in- comparison group, 2 did not evaluate the
fants, and large-for-gestational age included outcomes, and 8 involved the
infants. use of metformin after diagnosis of preg-
nancy. The final 23 articles that fully met
inclusion criteria were then reviewed,
Tabulation and integration and data tables were constructed. A total
This systematic review was preceded by a of 92,392 patients were included in the
detailed study protocol that stated the metaanalysis (2544 patients with PCOS
question to be addressed, the subgroups compared with 89,848 patients without
of interest, and the methods and criteria PCOS). Table 1 shows the characteristics
to be used for the identification and se- of each study. Women with PCOS were
lection of relevant studies and extraction noted to have higher rates of gestational
and analysis of information. Approval diabetes mellitus (odds ratio [OR], 2.82;
from the institutional review board 95% confidence interval [CI], 1.93–
was not required to perform this meta- 4.10), pregnancy-induced hypertension
analysis. With the use of computerized (OR, 4.07; 95% CI, 2.75– 6.02), pre-
databases, references of published sys- eclampsia (OR, 4.23; 95% CI, 2.77–
tematic reviews, and textbook chap- 6.46), preterm delivery (OR, 2.20; 95%
ters, potential articles were found and CI, 1.59 –3.04), cesarean delivery (OR,
reviewed.9,12 Search terms included 1.41; 95% CI, 0.96 –2.07), operative vag-
PCOS and pregnancy complications, inal delivery (OR, 1.56; 95% CI, 0.93–
PCOS and pregnancy outcomes, PCOS 2.63), small-for-gestational-age infants
and neonatal outcomes, PCOS and (OR, 2.62; 95% CI, 1.35–5.10), and
gestational diabetes mellitus, PCOS large-for-gestational-age infants (OR,
Kjerulff. Pregnancy outcomes and polycystic ovary and pregnancy and hypertension, 1.56; 95% CI, 0.92–2.64). Table 2 sum-
syndrome. Am J Obstet Gynecol 2011.
PCOS and preeclampsia, PCOS and marizes these results. Tables 3-5 specifi-
preterm labor, PCOS and cesarean sec- cally outline the odds ratio for the
tion delivery, PCOS and operative vag- primary outcomes. All pregnancy out-
cystic Ovary Syndrome (AE-PCOS) So- inal delivery, PCOS and forceps, and comes, except for gestational diabetes
ciety criteria, the 2003 Rotterdam crite- PCOS and vacuum delivery. mellitus, were evaluated with the use of a
ria were used to establish the diagnosis of Articles that were included for full re- fixed-effects model in which the ran-
PCOS. Specifically, the Rotterdam crite- view required the following information: dom-effects model was used. We used
ria require at least 2 of 3 features of (1) assessment of obstetric outcomes in Stata software (version11.0; StataCorp,
PCOS: (1) oligomenorrhea and/or an- women with PCOS that had been diag- College Station, TX) to perform the
ovulation, (2) clinical and/or biochemi- nosed by the Rotterdam criteria or the metaanalysis.
cal signs of hyperandrogenism, (3) poly- updated 2006 AE-PCOS criteria, (2)
cystic ovaries on ultrasound scanning.2 assessment of obstetric outcomes in
The revised 2006 AE-PCOS criteria ex- women without PCOS, and (3) met- C OMMENT
cluded patients who were not hyperan- formin could not have been used by the This metaanalysis confirms earlier find-
drogenic with only oligo/anovulation PCOS group after conception. We fol- ings regarding obstetrics patients with
and polycystic ovaries on ultrasound lowed the Meta-analysis of Observa- PCOS and also updates ORs for associ-
scanning from the diagnosis of PCOS tional Studies in Epidemiology group ated pregnancy complications. Although
but included the other phenotypes of guidelines for analyzing observational women with PCOS were noted to have
PCOS that had been determined by the studies in a metaanalysis.13 Two contrib- higher rates of previously mentioned
Rotterdam consensus.11 Because the utors independently assessed each arti- outcomes, only gestational diabetes
2006 AE-PCOS criteria are inherently cle, and any discrepancies were discussed mellitus, pregnancy-induced hyperten-
within the definition of the Rotterdam with 1 of 2 other contributors. sion, preeclampsia, preterm delivery,
criteria, these updated criteria were and small-for-gestational-age infants
used as an acceptable alternative to use R ESULTS were found to be statistically significant.
to diagnose PCOS in the more current Initial broad search results yielded 946 Furthermore, when compared with the
articles. Our primary outcomes in- possible articles (Figure). Later, 897 arti- 2006 study, the ORs increased for preg-
cluded gestational diabetes mellitus, cles were excluded because of duplica- nancy-induced hypertension, pre-
pregnancy-induced hypertension, and tion or irrelevance by title; then 12 arti- eclampsia, preterm delivery, and small-
preeclampsia. Secondary outcomes in- cles were excluded on the basis of the for-gestational-age infants (Table 6).

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TABLE 1
Characteristics of included studies
Group, n
Women with
polycystic ovary Control
Study Outcomes included syndrome patients Conception method Study type
Altieri et al14 GDM, PIH, preeclampsia, cesarean 15 159 Spontaneous, ovulation Retrospective
delivery, OVD, PTD, neonatal induction, ART
malformation
................................................................................................................................................................................................................................................................................................................................................................................
15
Hu et al PIH, preeclampsia 22 22 Spontaneous Prospective
................................................................................................................................................................................................................................................................................................................................................................................
16
Li et al Preeclampsia, PTD, macrosomia, 34 70 Spontaneous and ART Prospective
LGA, SGA
................................................................................................................................................................................................................................................................................................................................................................................
17
Maliqueo et al LGA, SGA 30 34 Spontaneous Prospective
................................................................................................................................................................................................................................................................................................................................................................................
18
Palomba et al GDM, PIH, preeclampsia, cesarean 93 69 Spontaneous Prospective
delivery, OVD, PTD, LGA, SGA,
placental abruption
................................................................................................................................................................................................................................................................................................................................................................................
19
Diamant et al Preeclampsia 70 71 Ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
20
Levran et al GDM 76 95 Spontaneous, ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
21
Wortsman et al GDM 53 2306 Spontaneous, ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
22
Cardenas et al GDM 31 78 Ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
23
Urman et al GDM, PIH, preeclampsia, PTD, NICU 47 100 Spontaneous, ovulation Retrospective
admission induction, ART
................................................................................................................................................................................................................................................................................................................................................................................
24
Fridstrom et al GDM, PIH, preeclampsia 33 66 Spontaneous, ovulation Retrospective
induction, ART
................................................................................................................................................................................................................................................................................................................................................................................
25
Radon et al GDM, preeclampsia 22 66 Spontaneous, ovulation Retrospective
induction, ART
................................................................................................................................................................................................................................................................................................................................................................................
Kashyap and PIH 22 27 Spontaneous, ovulation Retrospective
Claman26 induction, ART
................................................................................................................................................................................................................................................................................................................................................................................
27
Vollenhoven et al GDM, PIH, PTD 60 60 Spontaneous, ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
28
Mikola et al GDM, PIH, PTD 80 712 Ovulation induction Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
29
Bjercke et al GDM, PIH, preeclampsia, cesarean 52 335 Ovulation induction, ART Prospective
delivery, OVD, PTD, NICU admission
................................................................................................................................................................................................................................................................................................................................................................................
30
Haakova et al GDM, PIH, cesarean delivery, PTD 66 66 Spontaneous, unspecified ART Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
31
Turhan et al GDM, PIH, preeclampsia, cesarean 38 136 Not stated Retrospective
delivery, PTD, macrosomia,
neonatal malformation, abruption
................................................................................................................................................................................................................................................................................................................................................................................
32
Weerakiet et al GDM, PIH, preeclampsia, PTD 39 219 Spontaneous, ovulation Prospective
induction, ART
................................................................................................................................................................................................................................................................................................................................................................................
33
Sir-Peterman et al GDM, preeclampsia, PTD, LGA, SGA 47 180 Spontaneous, unspecified ART Prospective
................................................................................................................................................................................................................................................................................................................................................................................
34
Lesser and Garcia GDM 24 44 Unspecified ART Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
35
Lo et al GDM 1542 84882 Not stated Retrospective
................................................................................................................................................................................................................................................................................................................................................................................
36
Sir-Peterman et al GDM, PIH 48 51 Not stated Prospective
................................................................................................................................................................................................................................................................................................................................................................................
ART, assisted reproductive technique; GDM, gestational diabetes mellitus; LGA, large-for-gestational age; NICU, neonatal intensive care unit; OVD, operative vaginal delivery; PIH, pregnancy-induced
hypertension; PTD, preterm delivery; SGA, small-for-gestational age.
Kjerulff. Pregnancy outcomes and polycystic ovary syndrome. Am J Obstet Gynecol 2011.

This information should encourage tients are screened for these complica- lence and management of pregnancy
practitioners to be vigilant when caring tions, solely based on PCOS diagnosis. complications. As suggested in the 2006
for women with PCOS. Currently, there In addition to establishing causation, AE-PCOS task force report, pheno-
is insufficient evidence to establish cau- we also must investigate how the pheno- typic groups may include (1) full-blown
sation and to support changing how pa- typic variants of PCOS alter the preva- PCOS (hyperandrogenemia, hirsutism,

558.e3 American Journal of Obstetrics & Gynecology JUNE 2011

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TABLE 2
Summary of results
Group, n
Patients with polycystic Control patients with polycystic Odds ratio
Variable ovary syndrome Total ovary syndrome Total (95% CI)
Gestational diabetes mellitus 340 2385 5263 89,669 2.82 (1.93–4.10)
................................................................................................................................................................................................................................................................................................................................................................................
Pregnancy-induced hypertension 84 521 56 1317 4.07 (2.75–6.02)
................................................................................................................................................................................................................................................................................................................................................................................
Preeclampsia 63 589 57 2228 4.23 (2.77–6.46)
................................................................................................................................................................................................................................................................................................................................................................................
Preterm delivery 76 565 155 2129 2.20 (1.59–3.04)
................................................................................................................................................................................................................................................................................................................................................................................
Cesarean delivery 57 171 201 716 1.41 (0.96–2.07)
................................................................................................................................................................................................................................................................................................................................................................................
Operative vaginal delivery 43 160 62 583 1.56 (0.93–2.63)
................................................................................................................................................................................................................................................................................................................................................................................
Small-for-gestational age 29 204 16 353 2.62 (1.35–5.10
................................................................................................................................................................................................................................................................................................................................................................................
Large-for-gestational age 32 204 44 353 1.56 (0.92–2.64)
................................................................................................................................................................................................................................................................................................................................................................................
CI, confidence interval.
Kjerulff. Pregnancy outcomes and polycystic ovary syndrome. Am J Obstet Gynecol 2011.

oligo-anovulation, and polycystic-ap-

TABLE 3 pearing ovaries), (2) hyperandrogenism
Odds ratio for incidence of gestation diabetes mellitus of women with menstrual irregularities, (3) and/or
with polycystic ovary syndrome and control patients hyperandrogenism without menstrual
irregularities. Palomba et al18 are to date
Group (n/N)
the only investigators that have pub-
Women with lished an assessment in this manner. In
polycystic ovary Control their prospective controlled study that
Study syndrome patients Odds ratio (95% CI)
compared 97 patients with PCOS with 73
Altieri et al14 3/15 6/159 6.38 (1.41–28.72) healthy pregnant subjects, they found an
..............................................................................................................................................................................................................................................
18
Palomba et al 15/93 4/69 3.13 (0.99–9.88)
..............................................................................................................................................................................................................................................
overall increased risk for adverse obstet-
Levran et al 20
15/76 9/95 2.35 (0.97–5.72) ric and neonatal outcome but noted that
..............................................................................................................................................................................................................................................
21 this risk varied according to the different
Wortsman et al 4/53 153/2306 1.15 (0.41–3.22)
..............................................................................................................................................................................................................................................
22
phenotypes. Specifically, the relative risk
Cardenas et al 1/31 1/78 2.57 (0.16–42.37) for adverse obstetric and neonatal out-
..............................................................................................................................................................................................................................................
23
Urman et al 6/47 2/100 7.17 (1.39–37.01) comes were 1.93 (95% CI, 1.12–2.96) for
..............................................................................................................................................................................................................................................
Fridstrom et al 24
1/33 1/66 2.03 (0.12–33.54) full-blown phenotype, 2.23 (95% CI,
..............................................................................................................................................................................................................................................
Radon et al 25
9/22 2/66 22.15 (4.28–114.68)
1.21–3.15) for hyperandrogenic non-
..............................................................................................................................................................................................................................................
27
PCO type, 0.54 (95% CI, 0.09 –1.63)
Vollenhoven et al 13/60 10/60 1.38 (0.55–3.45)
.............................................................................................................................................................................................................................................. for nonhyperandrogenic type, and 0.48
28
Mikola et al 20/99 66/737 2.57 (1.48–4.47) (95% CI, 0.31– 0.78) for ovulatory phe-
..............................................................................................................................................................................................................................................
Bjercke et al 29
4/52 2/355 14.71 (2.62–82.46) notypes. This suggested that patients
..............................................................................................................................................................................................................................................
Haakova et al 30
3/66 8/66 0.36 (0.087–1.36) with PCOS can be further categorized as
..............................................................................................................................................................................................................................................
31
high-risk if they have full-blown PCOS
Turhan et al 1/38 11/136 0.31 (0.038–2.46)
.............................................................................................................................................................................................................................................. or have non-PCO hyperandrogenic phe-
32
Weerakiet et al 8/39 13/219 4.09 (1.57–10.66) notypes.18 Specific risk assessment of
..............................................................................................................................................................................................................................................
33
Sir-Petermann et al 6/47 1/180 26.20 (3.07–223.54) each phenotypic group may help identify
..............................................................................................................................................................................................................................................
Lesser and Garcia 34
4/24 3/44 2.73 (0.56–13.40) patients with high-risk PCOS vs patients
..............................................................................................................................................................................................................................................
35 with low-risk PCOS to improve effi-
Lo et al 221/1542 4970/84,882 2.69 (2.33–3.11)
.............................................................................................................................................................................................................................................. ciency of screening, diagnosis, and
36
Sir-Petermann et al 6/48 1/51 7.14 (0.827–61.71) treatment.
..............................................................................................................................................................................................................................................
TOTAL 340/2385 5263/89,669 2.82 (1.94–4.11) Another classification of PCOS that is
..............................................................................................................................................................................................................................................
Heterogeneity ␹2 ⫽ 36.19 (degrees of freedom ⫽ 17; P ⫽ .004); estimate of between-study variance Tau-squared ⫽ described frequently is “lean” vs “obese”
0.2369; test of odds ratio ⫽ 1: z ⫽ 5.42; P ⫽ .000. patients with PCOS. The difference of
CI, confidence interval.
Kjerulff. Pregnancy outcomes and polycystic ovary syndrome. Am J Obstet Gynecol 2011.
weight and body mass index between
these 2 phenotypes may be the cause of

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the marked heterogeneity that is noted

among the studies the have evaluated TABLE 4
gestational diabetes mellitus. A sub- Odds ratio for incidence of pregnancy-induced hypertension of women
group analysis that compared language with polycystic ovary syndrome and control patients
and date and country of publication did Group (n/N)
not explain the heterogeneity. We at-
Women with
tempted to investigate whether body polycystic ovary Control
mass index would account for this vari- Study syndrome patients Odds ratio (95% CI)
ation, but few studies included patient Altieriat et al14 2/15 10/159 2.29 (0.45–11.59)
..............................................................................................................................................................................................................................................
weight in their data, and even fewer stud- 15
Hu et al 6/22 0/22 17.73 (0.93–337.26)
ies documented body mass index. An in- ..............................................................................................................................................................................................................................................
18
depth metaregression that compared Palomba et al 13/93 3/69 3.58 (0.98–13.08)
..............................................................................................................................................................................................................................................
body mass index and age among women Urman et al 23
12/47 8/100 3.94 (1.49–10.46)
..............................................................................................................................................................................................................................................
with and without PCOS might illumi- Fridstrom et al 24
6/33 3/66 4.67 (1.09–20.04)
..............................................................................................................................................................................................................................................
nate reasons for variability between
Kashyap and 7/22 1/27 12.13 (1.36–108.36)
studies. Claman26
Last, we must examine how the use of ..............................................................................................................................................................................................................................................
27
metformin past the first trimester may Vollenhoven et al 10/44 3/44 4.02 (1.02–15.79)
..............................................................................................................................................................................................................................................
29
decrease pregnancy complications. It is Bjercke et al 6/52 1/355 46.17 (5.44–392.13)
..............................................................................................................................................................................................................................................
already known that PCOS increases the Haakova et al 30
5/66 4/66 1.27 (0.33–4.96)
..............................................................................................................................................................................................................................................
baseline insulin resistance of pregnancy. Turhan et al 31
4/38 9/136 1.66 (0.48–5.72)
Separately, metformin is known to de- ..............................................................................................................................................................................................................................................
32
crease this state of insulin resistance in Weerakiet et al 9/41 14/222 4.18 (1.67–10.45)
..............................................................................................................................................................................................................................................
33
patients with PCOS. Although the use of Sir-Petermann et al 4/48 0/51 10.42 (0.55–198.83)
..............................................................................................................................................................................................................................................
metformin alone or in combination with TOTAL 84/521 56/1317 4.07 (2.75–6.02)
..............................................................................................................................................................................................................................................
clomiphene has not been shown to im- Heterogeneity ␹2 ⫽ 12.64 (degrees of freedom ⫽ 11; P ⫽ 0.317); test of odds ratio ⫽ 1: z ⫽ 7.03; P ⫽ .000.
prove live birth rates, clinical pregnancy CI, confidence interval.
rates are improved when compared with Kjerulff. Pregnancy outcomes and polycystic ovary syndrome. Am J Obstet Gynecol 2011.
placebo.1 Currently, 3 controlled trials
and 3 observational studies have investi-
gated the prevention of gestational dia- TABLE 5
betes mellitus by continuing metfor- Odds ratio for the incidence of preeclampsia for women
min therapy throughout pregnancy in with polycystic ovary syndrome and control patients
women with PCOS, but the sample sizes Group (n/N)
are small, and the results are conflicting.
Polycystic ovary Control
An initial metaanalysis of the use of met- Study syndrome patients Odds ratio (95% CI)
formin throughout pregnancy was per- 14
Altieri et al 0/15 2/159 2.03 (0.09–44.26)
formed but did not show a statistically ..............................................................................................................................................................................................................................................
16
significant reduction of gestational dia- Li et al 6/34 4/70 3.54 (0.93–13.51)
..............................................................................................................................................................................................................................................
betes mellitus. Palomba et al 18
9/93 1/69 7.29 (0.90–58.94)
..............................................................................................................................................................................................................................................
Inherent to the nature of observa- Diamant et al 19
20/70 3/71 9.07 (2.55–32.20)
tional studies are the main limitations to ..............................................................................................................................................................................................................................................
23
Urman et al 3/47 4/100 1.64 (0.35–7.62)
this study: heterogeneity and lack of pro- ..............................................................................................................................................................................................................................................
24
spective data to establish causation. De- Fridstrom et al 3/33 0/66 15.26 (0.76–304.73)
..............................................................................................................................................................................................................................................
spite its limitation, this study is still Radon et al 25
5/22 1/66 19.12 (2.09–174.70)
..............................................................................................................................................................................................................................................
useful for clinical practice. Physicians Mikola et al 28
4/99 14/737 2.17 (0.70–6.74)
should continue to consider patients ..............................................................................................................................................................................................................................................
29
Bjercke et al 7/52 25/355 2.05 (0.84–5.02)
with PCOS to be high risk and to moni- ..............................................................................................................................................................................................................................................
31
tor them closely for the development of Turhan et al 3/38 2/136 5.74 (0.92–35.71)
..............................................................................................................................................................................................................................................
gestational diabetes mellitus, pregnancy- Weerakiet et al 32
1/39 1/219 5.74 (0.35–93.70)
..............................................................................................................................................................................................................................................
induced hypertension, and preeclamp- Sir-Petermann et al 33
2/47 0/180 19.84 (0.94–420.39)
sia. Hypertensive disorders in PCOS may ..............................................................................................................................................................................................................................................
TOTAL 63/589 57/2228 4.23 (2.77–6.46)
be due to low levels of insulin-like ..............................................................................................................................................................................................................................................

growth factor binding globulin-1 and Heterogeneity ␹2 ⫽ 10.87 (degrees of freedom ⫽ 11; P ⫽ .454); test of odds ratio ⫽ 1: z ⫽ 6.69; P ⫽ .000.
CI, confidence interval.
therefore may account for the increase in Kjerulff. Pregnancy outcomes and polycystic ovary syndrome. Am J Obstet Gynecol 2011.
pregnancy-induced hypertension and

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www.AJOG.org SAAOG Papers
ovary syndrome. J Reprod Med 1991;36:
TABLE 6 659-61.
Comparison of the odds ratios of the current and previous metaanalyses 22. Cardenas M, Coulson CC, Legro RS. Infer-
tile PCOS women do not have an increased risk
Odds ratio (95% CI) for gestational diabetes or macrosomia [ab-
stract]. Hum Reprod Update 2006;12:673-83.
Variable Current study (2010) Boomsma et al5 (2006)
23. Urman B, Sarac E, Dogan L, Gurgan T. Preg-
Pregnancy-induced hypertension 4.07 (2.75–6.02) 3.67 (1.98–6.81) nancy in infertile PCOD patients, complications
..............................................................................................................................................................................................................................................
and outcome. J Reprod Med 1997;42:501-5.
Preeclampsia 4.23 (2.77–6.46) 3.47 (1.95–6.17)
.............................................................................................................................................................................................................................................. 24. Fridstrom M, Nisell H, Sjoblom P, Hillensjo
Preterm delivery 2.20 (1.59–3.04) 1.75 (1.16–2.62) T. Are women with polycystic ovary syndrome
..............................................................................................................................................................................................................................................
at an increased risk of pregnancy-induced hy-
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